Case Study - Page 3

How does this work in practice? In Sensorimotor Psychotherapy, as we notice habitual emotional or somatic responses, we ask clients to pause during recitations of past events and current difficulties, and then notice what's happening in their bodies. In this way, old responses are spontaneously interrupted as the client directs attention in a mindful way to the experience of the present moment.

When Carrie was asked to see what was happening "inside" as she recounted her husband's latest outburst, she first noticed a feeling of fear and the sensation that her heart was racing, and then she tightened up and stopped breathing for a moment. Her body felt rigid. Encouraged to keep observing what was happening, she noticed that her shoulders and chest suddenly felt heavy and sunken, and feelings of sadness welled up, to which she attached the word "hopeless." She felt paralyzed, unable to speak or act. Her body couldn't shift its longstanding childhood "script." She felt little, scared, sad, and helpless.

Because neuroplastic change requires mindful attention to inhibiting habitual responses and the repetition of something new, Carrie's therapist asked her to focus just on these deflated sensations and then notice what happened inside if she lengthened her spine slightly. "I can breathe," she said with surprise. Her gaze could now take in the room, and she and her therapist noticed that her body was no longer collapsed. Gone, too, was the hopeless feeling. Instead, she was laughing: "The weirdest thing is the doctors say I have emphysema, but right now I'm breathing without effort."

When we freeze like the proverbial "deer in the headlights," all movement, including the breath, is inhibited. As Carrie lengthened her spine, she "unfroze" and counteracted the submission responses in her chest and shoulders—a signal to the body to breathe again. To this day, she experiences an increased ability to breathe normally whenever she remembers to lengthen her spine.

In this first session, we repeatedly used the image of her husband's most recent angry outburst to stimulate the old responses. As she envisioned his belligerent expression and menacing tone, her body would respond in its habitual way, and then she'd practice the simple intervention of lengthening her spine until, after six to eight trials, it became easier and more automatic. The therapy session had become more like a gym session with a personal trainer: the same physical movements rehearsed again and again. In this way, Carrie was learning to redirect her attention from her old, automatic freezing response to a new physical posture, which immediately made her feel less afraid and hopeless, more solid and confident.

That night, when her husband's irritability threatened to trigger the old freeze-and-collapse reaction and reduce her to tears, she remembered to lengthen her spine and focus on that physical movement, rather than her habitual feelings. Much to her surprise, after a few seconds, he didn't seem so frightening, and she didn't feel as compelled to soothe him. She did feel more empathy toward him, noticing how hard it was for him to tolerate his increasing physical frailty. But for the first time, she began to consider that this really was his problem, not hers.

At the next session, thoughts of her husband's impending return from a business trip activated Carrie's fears of an angry tirade induced by the strain of travel. How would he act? How would she respond? At this session, after a brief discussion of her anxiety, she was asked to inhibit the oft-told narrative about his behavior to focus on her body and then to notice what happened if she raised both arms and hands to make a "Stop" gesture. At first, she experienced positive feelings of solidity and strength, but as she continued to focus attention on these movements, sadness came up, accompanied by a sense of heaviness around her heart. "After all these years, I have to shut him out to feel safe. It's so lonely. I miss him," she said, her chest caving a little as if she were carrying the weight of the loss.